News
July 2011 Monthly Advocacy Update
CANCER RESEARCH AND PREVENTION PROGRAMS
With negotiations over the debt limit and deficit preoccupying Congressional leaders and the White House, ACS CAN wrote to the president and the bipartisan leadership of the House and Senate today asking that a full scale effort against cancer be made a top priority as negotiations continue. Read the letter and press release.
Throughout the summer ACS CAN grassroots advocates are engaging in an effort to sustain federal funding for cancer programs. Activities include in-person meetings with representatives and senators, constituent phone calls, and the collection of petitions marking milestones in the lives of people fighting cancer. The milestones will be used as part of the lead up to September’s Celebrate with Action events marking the 10th Anniversary of ACS CAN and culminating in the annual ACS CAN Leadership Summit and Lobby Day.
ACS CAN and the California Division teamed up with the University of California San Diego (UCSD) on June 28 for an event at the UCSD Moores Cancer Center. US Representative Bob Filner (D-CA) was a featured speaker. Guests also heard from cancer research scientists. Immediately prior to the event, the media and principal speakers toured the Center’s research facilities. The event is the second of its kind this year, following one ACS CAN, the High Plains Division, and MD Anderson in Houston hosted in the spring. A third cancer center event is scheduled for August 25 at the University of Alabama-Birmingham.
Litigation Update
On June 27, the U.S. Court of Appeals for the Sixth Circuit issued the first appellate decision in litigation challenging the constitutionality of the Affordable Care Act. The court upheld the law, reasoning that Congress had acted within its constitutional authority when it required individuals to purchase health insurance (the so-called individual mandate). One of the leading conservatives on the court -– George W. Bush appointee Jeffrey Sutton -– wrote the concurring opinion, making him the first Republican-nominated judge to rule in favor of upholding the mandate.
As you know, the American Cancer Society and ACS CAN, along with the American Diabetes Association and the American Heart Association, filed an amicus brief with the Sixth Circuit and the other circuits hearing appeals. The brief outlines the need for the Affordable Care Act's protections for patients with chronic illnesses, and cites studies linking cancer outcomes with insurance status. Read a joint statement from the groups in response to the Sixth Circuit ruling.
Decisions in similar cases challenging the Affordable Care Act are pending in the Fourth and Eleventh Circuits, which heard arguments on June 1 and June 8 respectively. Rulings are expected before Labor Day. The Supreme Court is likely to accept the appeals during its 2011 fall term, with a final decision issued in the spring of 2012.
State Update
Ten states -– California, Colorado, Hawaii, Illinois, Maryland, Nevada, Oregon, Vermont, Washington and West Virginia –- have had health insurance exchange legislation signed into law. Two states -- Connecticut and North Carolina -- have exchange bills awaiting gubernatorial action. In addition, the governors of Alabama, Georgia and Indiana issued executive orders to create panels to study exchanges, while the governors of Mississippi, North Dakota, Virginia and Wyoming signed bills that allow the legislative process to move forward without yet establishing an exchange.
High Risk Pools
On July 1, improvements went into effect intended to make the Pre-Existing Condition Insurance Plan (PCIP), the Affordable Care Act-created high-risk pool, easier to access and more affordable. As a result, patients in states with federally-run PCIPs will see premiums reduced by as much as 40 percent. In addition, applicants can now provide a letter from a health care provider dated within the past 12 months attesting to the patient’s serious medical condition, disability, or illness to establish eligibility. Until now patients had to produce a denial letter from an insurance company to qualify. Patients must still demonstrate that they have been uninsured for six months or more.
For more information, visit www.pcip.gov or call 1-866-717-5826 (TTY 1-866-561-1604) toll-free. Information about the improvements to PCIP will also be available on the Health Care & You website, the collaboration involving ACS CAN, AARP, the American Medical Association, and other national health groups that is educating the public about the new law.
Prevention
National Prevention Strategy
The Department of Health and Human Services (HHS) led several federal agencies in releasing the nation’s first-ever National Prevention and Health Promotion Strategy. Developed by the National Prevention, Health Promotion, and Public Health Council, which was formed under the Affordable Care Act, this comprehensive strategy focuses on coordinating prevention, wellness and health promotion efforts within the federal government and in communities around the nation. Society and ACS CAN Chief Executive Officer John R. Seffrin, PhD, sits on the Council’s Advisory Group, which played a key role in developing the strategy. Read the ACS CAN statement.
Preventive Benefits in Medicare
The Centers for Medicare and Medicaid Services (CMS) reports that as of June 10, 2011, more than 5 million Americans with traditional Medicare took advantage of one or more of the recommended preventive benefits now available for free such as mammograms and colorectal cancer screening. Earlier this year, as called for in the Affordable Care Act, Medicare eliminated deductibles and copayments for a host of preventive services, including some cancer screenings, tobacco cessation, and hepatitis B shots. CMS also eliminated out-of-pocket costs for the “Welcome to Medicare” preventive visit, and, for the first time since the Medicare program was created in 1965, Medicare now covers an annual wellness visit with a participating doctor, also at no cost. CMS has also launched an outreach and education campaign -- Share the News, Share the Health -- to promote the benefits throughout the summer with online ads and community events held around the country.
Grants
HHS announced the availability of $10 million in grants to organizations with the expertise and capacity to operate workplace wellness programs that encourage healthy lifestyles and reduce chronic disease risk. HHS also announced the availability of approximately $40 million more in grants from the Affordable Care Act-created Public Health and Prevention Fund for statewide chronic disease prevention programs.
Accountable Care Organizations (ACOs)
ACS CAN filed comments with CMS on the proposed Medicare regulation creating Accountable Care Organizations (ACOs) that acknowledged the potential of ACOs to improve the health and quality of care of cancer patients and expressed appreciation for the regulation’s strong emphasis on providing patient-centered, coordinated care for individuals with chronic conditions. Read the ACS CAN press release.
There were also areas, however, that ACS CAN urged CMS to strengthen, including palliative care services as an integral component of ACOs and other proposed models. ACS CAN also recommended that HHS more carefully consider several patient-specific issues in the regulation, such as:
Enhancing patient participation in ACO governance;
Requiring providers to deliver evidence-based cancer care;
Encouraging all ACO participants to share claims information with their providers so
treating physicians have the best information to deliver appropriate, high quality care; and,
Redefining “at-risk beneficiaries” to ensure that plans are not incentivized to avoid
patients with chronic conditions such as cancer.
External Appeals
The Administration released an amendment to a previous regulation on external appeals. As a result, virtually all people enrolled in private insurance have the right to an external appeal. The external review panel’s decision would be binding. (The requirement does not apply to people enrolled in plans that were in existence before March 23, 2010 -– so called “grandfathered plans,”)
Unfortunately, the regulation is not as consumer friendly as it could be. Keeping the consumer foremost is particularly important, especially for cancer patients who need to have disputes resolved quickly and fairly. Most notably, the scope of what can be appealed is limited to issues of "medical judgment.” While medical judgment encompasses many possible disputes, the requirement fails to address a significant proportion of claims that are based on other factors, such as administrative coding errors, failure to receive pre-authorization, and insurers arguing that a benefit is not covered. A further concern is the narrower timeframe in which patients can file an appeal and the time-lag until the issue is resolved.
Because this is an interim final regulation it takes effect as written now; however, it can be amended later based on public feedback. ACS CAN intends to file comments advocating for enhancements that would make for a more consumer-friendly external appeals process. Read the ACS CAN statement.
Health Disparities
HHS announced new draft standards to improve the monitoring of health data by race, ethnicity, sex, primary language, and disability status. The proposed standards are intended to help federal agencies refine their population health surveys so that researchers can better understand health disparities and better implement effective strategies to eliminate them.
Mini-med Waivers to End
CMS announced that after September 22, 2011 it would stop accepting new applications from, or grant renewals to, limited benefit health plans -- also known as “mini-meds -- seeking waivers from Affordable Care Act provisions that set higher dollar coverage minimums than these bare-bones plans provide. The waivers are being phased out to prepare for the ban on annual limits that takes effect in 2014. Until then, plans that receive waivers must disclose any such limits to consumers. For more about mini-meds, read ACS CAN Senior Director for Policy Steve Finan’s December 2010 testimony before to the US Senate Commerce, Science and Transportation.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT (FSPTCA)
The Food and Drug Administration (FDA) unveiled new graphic health warning labels on cigarette packs and advertisements on June 21. The labels will cover 50% of the front and back of cigarette packages and 20% of cigarette advertisements starting in September 2012. The labels will also include the phone number 1-800-Quit-Now, which connects callers with state cessation programs. Creation and placement of the new labels are one of the key provisions in the Family Smoking Prevention and Tobacco Control Act. Read the ACS CAN press release.
Also in June, ACS CAN and its partners ensured the defeat of legislation that would have undercut the FDA’s authority to regulate tobacco products. First, the House of Representatives rejected, by a vote of 257-164, an amendment to the agriculture appropriations bill that would have cut the tobacco industry user fees that fund the FDA tobacco regulation program. Later, a procedural point of order was raised on the House floor to strike an amendment adopted in the Appropriations Committee that would have severely restricted the FDA’s ability to regulate tobacco products -- including menthol.
ACS CAN RELEASES TOBACCO REPORTS
ACS CAN released two reports on the health and economic benefits of strong statewide tobacco control policies on June 15. The state-by-state analysis measures deaths averted, smokers quitting, and health cost savings due to comprehensive smoke-free laws or tobacco tax increases. With ACS CAN and Society Divisions pushing back hard against attempts to roll back taxes and weaken or repeal comprehensive smoke-free laws, the reports arm advocates and lawmakers with further concrete evidence that smoke-free laws and tobacco taxes are a win-win -- they save lives and money.
Congratulations to the Great Lakes Division where the Delaware County Board of Commissioners in Indiana unanimously adopted a comprehensive smoke-free workplace ordinance. The vote came after a public hearing where lung cancer survivor and ACS CAN member Michael Kelley delivered compelling testimony about his years of exposure to secondhand smoke while working in car assembly plants.
In the Great West, ACS CAN scored a win in Alaska, where the state Supreme Court upheld the city of Juneau’s ordinance banning smoking in private clubs. But the victory is tempered by a disappointing turn of events in Nevada, where the legislature passed a bill that considerably weakened the state’s smoke-free law. ACS CAN volunteers and staff made a very strong case against the legislation, but the legislature passed the measure late at night, just minut